Radiation‐induced skin ulcer and rib fractures following percutaneous coronary intervention (PCI): A case of right back skin ulcer and adjacent rib fractures after single PCI

Abstract

We experienced a 75-year-old male patient with a refractory and severely painful skin ulcer on the right back. He had suffered from ischemic heart disease and undergone percutaneous coronary intervention 5 months prior to the consultation with us. The characteristic clinical appearance, location of the lesion and his past medical history led us to the diagnosis of radiation-induced skin ulcer. Magnetic resonance imaging, computed tomography as well as bone scintigraphy showed fractures of the right back rib adjacent to the ulcer, which was thought to be attributable to bone damage due to X-ray radiation and/or persistent secondary inflammation of the chronic ulcer. In the published work, there are no other reports of bone fractures associated with radiation dermatitis after coronary interventional radiology.

Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates

“…None of the patients in this study experienced radiation damage to the skin as a testimony to the applied radiation safety measures of changing radiation fields in long procedures. It is important to inform and instruct the patients on these potential complications, as they may occur several days after discharge, and are not intuitively related to the procedure as they will appear on the back of the patient .…”

Technical Note: Characterization of x‐ray beam profiles for a fluoroscopic system incorporating copper filtration

“…Radiation doses from fluoroscopically guided interventional (FGI) procedures can exceed thresholds for inducing tissue reactions; these reactions primarily affect the skin, but some reports have documented damage to other organs and anatomic structures at depth below the skin surface . Skin dose mapping techniques developed to refine the geometric distribution of the surface radiation dose are becoming more common on fluoroscopes used for FGI procedures .…”

Management of fluoroscopy-induced radiation ulcer: One-stage radical excision and immediate reconstruction

“…Recently, we noticed an increasing incidence of severe radiation dermatitis in our hospital 4 . Moreover, the trend is worldwide 5 6 7 8 9 10 11 12 13 .…”